Henrik Støvring

Rising prevalence of diabetes: evidence from a Danish pharmacoepidemiological database.

The prevalence of diabetes has increased worldwide. We have undertaken an epidemiological analysis of drug-treated diabetes in a well defined community. We present estimates of prevalence, incidence, and mortality of patients with such diabetes during 1993-, based on data for all 470000 people living in the county of Fyn, Denmark. Although prevalence increased (odds ratio: female, 1.026 [95% CI 1.020-1.032]; male, 1.041 [1.036-1.047]), mortality in those treated declined (rate ratio: female, 0.976 [95%CI 0.952-1.001]; male, 0.966 [0.943-0.990]). We did not identify a clear trend for incidence. Future research into the causes of rising diabetes prevalence should take this fall in mortality into account to avoid incorrect conclusions about the relation between western lifestyle and the growing number of diabetics.

Proton Pump Inhibitor or Testing for Helicobacter pylori as the First Step for Patients Presenting with Dyspepsia? A Cluster-Randomized Trial

OBJECTIVES:The optimal approach for management of patients with dyspepsia has not been determined. The aim of this study was to compare the efficacy of three strategies for management of dyspepsia: empirical antisecretory therapy, testing for Helicobacter pylori (H. pylori), or a combination of the two.METHODS:Cluster-randomized trial in general practices. Initial treatment with proton pump inhibitor (PPI) was performed in 222 patients, H. pylori test-and-eradicate in 250 patients, and PPI followed by H. pylori-testing if symptoms improved in 250 patients. Symptoms, quality of life, patient satisfaction, and use of resources were recorded during a 1-yr follow-up.RESULTS:The prevalence of H. pylori infection was 24%. We found no difference among the three strategies (p = 0.16) in terms of the proportion of days without dyspeptic symptoms. After 1 yr gastrointestinal symptom scores and quality-of-life scores had improved significantly and equally in the three groups (p < 0.001), but no statistically significant differences were found among the groups. The mean use of endoscopies per patient after 1 yr was higher in the PPI group (0.36 [95% CI 0.30–0.43]) than in the test-and-eradicate group (0.28 [95% CI 0.23–0.34]) and the combination group (0.22 [95% CI 0.17–0.27]), p = 0.02. H. pylori-positive patients given eradication therapy had more days without dyspeptic symptoms (p < 0.001), used less antisecretory therapy (p < 0.01), and were more satisfied (p < 0.001) than H. pylori-negative patients.CONCLUSION:The strategies based on H. pylori test enjoyed similar symptom resolution, but reduced endoscopic workload and lower 1-yr total costs compared with empirical antisecretory therapy.

The effect of different alcohol drinking patterns in early to mid pregnancy on the child’s intelligence, attention, and executive function

Please cite this paper as: Kesmodel U, Bertrand J, Støvring H, Skarpness B, Denny C, Mortensen E, the Lifestyle During Pregnancy Study Group. The effect of different alcohol drinking patterns in early to mid pregnancy on the child’s intelligence, attention, and executive function. BJOG 2012;119:1180–1190.

Do genetic factors contribute to the association between birth weight and blood pressure

OBJECTIVES To evaluate whether genetic factors contribute to the association between low birth weight and increased blood pressure among adolescents. DESIGN Historical cohort study of twin pairs. It was evaluated whether (1) a negative association between birth weight and systolic blood pressure was found in the overall twin sample and (2) whether the intrapair difference in birth weight correlated with the intrapair difference in systolic blood pressure—thereby controlling for the effect of genetic factors (all in monozygotic and on average half in dizygotic pairs). SETTING The Minnesota Twin Family Study. PARTICIPANTS 1311 pairs of adolescent twins. MAIN RESULTS A negative association between birth weight and systolic blood pressure was retrieved in the overall sample. The regression coefficient after controlling for current weight was −1.88 mm Hg/kg (SE 0.61), which corresponds to results from previous studies of singleton adolescents. The regression coefficient fell to −0.64 mm Hg/kg (SE 0.86) when the intrapair analyses were used. The largest reduction was observed among monozygotic twins: from −2.44 mm Hg/kg (SE 0.75) in the overall monozygotic twin sample to −1.06 mm Hg/kg (SE 1.14) in the analyses of the within monozygotic pair differences. CONCLUSION The association between low birth weight and increased blood pressure later in life is well established. “The fetal programming hypothesis” suggests that the association is caused by intrauterine malnutrition while a new hypothesis “the fetal insulin hypothesis” proposes that genetically determined insulin resistance also contributes significantly to the association. A recent twin study of middle aged twins showed no evidence for an influence of genetic factors while this larger study provides support for the fetal insulin hypothesis: the association between birth weight and blood pressure attenuated among adolescents when genetic factors were controlled. Together this suggests an important contribution of genetic factors to the association between fetal growth and systolic blood pressure in adolescence.

The effects of low to moderate alcohol consumption and binge drinking in early pregnancy on executive function in 5‐year‐old children

Please cite this paper as: SkogerbøÅ, Kesmodel U, Wimberley T, Støvring H, Bertrand J, Landrø N, Mortensen E. The effects of low to moderate alcohol consumption and binge drinking in early pregnancy on executive function in 5‐year‐old children. BJOG 2012;119:1201–1210.

The effect of alcohol binge drinking in early pregnancy on general intelligence in children

Please cite this paper as: Kesmodel U, Falgreen Eriksen H, Underbjerg M, Kilburn T, Støvring H, Wimberley T, Mortensen E. The effect of alcohol binge drinking in early pregnancy on general intelligence in children. BJOG 2012;119:1222–1231.

The effects of low to moderate prenatal alcohol exposure in early pregnancy on IQ in 5-year-old children.

Please cite this paper as: Falgreen Eriksen H, Mortensen E, Kilburn T, Underbjerg M, Bertrand J, Støvring H, Wimberley T, Grove J, Kesmodel U. The effects of low to moderate prenatal alcohol exposure in early pregnancy on IQ in 5‐year‐old children. BJOG 2012;119:1191–1200.

The male-female health-survival paradox: a survey and register study of the impact of sex-specific selection and information bias.

PURPOSE This study examined whether the health-survival paradox could be due partially to sex-specific selection and information bias in surveys. METHODS The study is based on the linkage of three population-based surveys of 15,330 Danes aged 46-102 years with health registers covering the total Danish population regarding hospitalizations within the last 2 years and prescription medicine within 6 months before the baseline surveys. RESULTS Men had higher participation rates than women at all ages. Hospitalized women and women taking medications had higher participation rate compared with nonhospitalized women (difference=0.7%-3.0%) and female nonusers (difference=0.8%-7.6%), respectively, whereas no consistent pattern was found among men according to hospitalization or medication use status. Men used fewer medications than women, but they underreported medication use to a similar degree as did women. CONCLUSIONS Hospitalized women, as well as women using prescription medicine, were slightly overrepresented in the surveys. Hence, the study found some evidence that selection bias in surveys may contribute to the explanation of the health-survival paradox, but its contribution is likely to be small. However, there was no evidence for sex-specific reporting of medication use among study participants.

Characteristics of middle-aged and elderly women with urinary incontinence.

Objective. To describe the prevalence of urinary incontinence and to find characteristics useful in general practice for identifying middle-aged and elderly women with the problem. Design. Cross-sectional interview study. Setting. Population-based samples of Danes. Subjects. A total of 5795 women older than 45 years (46+ years). Main outcome measures. Prevalence of incontinence and clinical characteristics assessed by standardized interview questions. Results. The overall prevalence of urinary incontinence was 20% among women less than 60 years of age and 44% among those older than 80 years. Increasing age was highly associated with both forms of incontinence (stress and urge). High body mass index (BMI), chronic lung disease, and stroke were also associated with both forms, while number of children was associated with stress incontinence only. Predictive models show that 56% of women characterized by high age (older than 80 years) and overweight (BMI higher than 30) will suffer from urinary incontinence. The low-risk group defined by these two parameters (aged 46–60 years and not overweight) still had a 19% prevalence in the last month. Conclusion. The prevalence of urinary incontinence increased with age. Even in the low-risk groups the problem was very common in old age. Questions about incontinence should, therefore, be asked in relevant consultations with all elderly female patients.

Does persistent involvement by the GP improve palliative care at home for end-stage cancer patients?

Objective: To analyse the effect of GP home visits on the granting of a terminal declaration (TD) and on place of death. Participants and design: A total of 2025 patients with cancer as the primary cause of death in the period 1997-1998, were investigated in a mortality follow-back design using the Danish Cancer Register and four administrative registers. The Danish TD can be issued by a physician for patients with an estimated prognosis of six months or less. The TD gives the right to economic benefits and increased care for the dying patient. Setting: The island of Funen/Denmark. Main outcome measures: Main outcome hospital death. Intermediate outcome TD. Results: A total of 38% of patients received a TD and 56% died in hospital. GP home visits in the week before TD (odds ratio (OR): 16.8; 95% CI: 8.2-34.4), as well as four weeks before TD (OR: 6.4; 95% CI: 4.5-9.2) were associated with an increased likelihood of receiving a TD. GP home visits in the group with TD (OR: 0.18; 95% CI: 0.11-0.29) and the group without TD (OR: 0.08; 95% CI: 0.05-0.13) was inversely associated with hospital death. A dose-response relationship was found in both groups. Conclusion: Persistent involvement by the GP is associated with improved end-of-life care for cancer patients. Provided that temporal relations are taken into account, the mortality follow-back design can be a suitable and ethical research method to highlight and monitor end-of-life cancer care.